Individual provider Active NPI

Troy Williamson

  • Physician Assistant
  • Los Alamitos, CA
National Provider Identifier
1750166591
Registry record updated Jan 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA63942 Issued in CA
Practice address
3751 Katella Ave
Los Alamitos, CA 90720-3113
Phone
(562) 598-1311
NPI assigned
Aug 29, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X PA63942 CA Primary

Addresses

Primary practice location

3751 Katella Ave
Los Alamitos, CA 90720-3113

Mailing address

3449 Watermarke PL
Irvine, CA 92612-5620
Phone (606) 548-0352

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240312000512 CA Practitioner - Physician Assistant 5092151175 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
63942CAMDPharmacist
PA63942CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America-California CurrentSince Feb 15, 2024 Accepting new patients
Cep America - California CurrentSince Feb 15, 2024 Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706313600000",
    "number": "1750166591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3449 WATERMARKE PL",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926125620",
            "telephone_number": "606-548-0352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3751 KATELLA AVE",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907203113",
            "telephone_number": "562-598-1311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMSON",
        "first_name": "TROY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-08-29",
        "last_updated": "2024-01-27",
        "certification_date": "2024-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA63942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Alamitos, CA

Sources for this page

Verify at the official NPI Registry.